Inspection on 25/09/08 for Holly Court

This inspection was carried out on 25th September 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holly Court 23/11/06

Holly Court 11/02/06

Holly Court 18/10/05

Holly Court 31/01/05

Holly Court 16/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holly Court 8 Priory Grove Salford Gtr Manchester M7 2HT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Steve Chick     Date: 2 5 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Holly Court 8 Priory Grove Salford Gtr Manchester M7 2HT 01617080174 01617050656 hollycourt@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross Healthcare Services Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: One named individual currently accommodated is below 65 years of age. If this service user leaves, the service user category will revert to DE(E). Date of last inspection Brief description of the care home Holly Court is a care home offering personal care only to 25 older people diagnosed with dementia. The home is situated in a residential area of Salford within close walking distance of local community facilities. Holly Court is a purpose built provision owned by Southern Cross Healthcare. The accommodation comprises of 25 single ensuite rooms and appropriate communal facilities on two floors. Catering and laundry are conducted from Laburnum Court, a provision in close proximity to the home and also owned and managed by Southern Cross Healthcare. Fees for accommodation at the home are £373.52 to £480.00 per week. Additional costs; Hairdressing, newspapers, toiletries, chiropody and aromatherapy. 1 Over 65 24 Care Homes for Older People Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. We (the Commission for Social Care Inspection) undertook a key inspection, which included an unannounced visit to the home. This meant that no one at Holly Court knew that the visit was going to take place. All the key inspection standards were assessed at the site visit. Four relatives of service users were interviewed in private, as were three staff members. Additionally, discussion took place with the manager. Due to the service users mental health needs, none were interviewed in private. Care Homes for Older People Page 5 of 27 We also looked at information we have about how the service has managed any complaints, what the service has told us about things that have happened in the service, these are called notifications, and any relevant information from other organisations. Before the site visit, we asked for surveys to be given to residents, relatives and staff, asking what they thought about the care at the home. Five resident surveys, six relatives surveys and one staff survey were returned to us. Some of the information from these surveys is included in the report. We also asked the management of the home to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA). This is a legal requirement. The AQAA told us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, some of these comments have been included in the report. We undertook a tour of the building and looked at a selection of service user and staff records as well as other documentation, including staff rotas, medication records and the complaints log. We have been informed of some complaints to the service since our last Key Inspection, which have been dealt with appropriately. We are aware of one safeguarding issue which was still subject to resolution at the time of this key inspection. The significant majority of views expressed to us were positive about the care service users received at Holly Court. Comments included : for the kindness and attention they get you couldnt better it Brilliant, absolutely brilliant ... [X] is very well cared for, always clean and tidy and happy, ... she loves her junk jewellery which the staff take the time to sort out for her. ... much to our delight it is always clean and tidy. The food is lovely and well presented. After a very difficult decision to allow [X] to go into care we are very pleased with the overall care she receives. There is always a homely friendly feel about the place and the residents feel relaxed. Staff seem pleasant and caring to the residents. Our relative feels like she is in control of her daily routine while the staff guide her through it at her own pace. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 27 Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are appropriately assessed and they, or their representatives, are able to visit before a decision is made that the home is appropriate for them. Evidence: At the last key inspection quality in this outcome group was found to be good. The Annual Quality Assurance Assessment (AQAA) stated that each service user had a proper assessment before being admitted into the home and that they or their families were encouraged to visit the home to ensure that the environment will be right for them. The manager reported that he personally undertook assessments of prospective service users and would not offer a place at the home if he did not feel that Holly Court could meet and service users needs. Care Homes for Older People Page 10 of 27 Evidence: During the unannounced site visit a selection of service users files was looked at. All had a copy of an assessment which had been undertaken before the service user moved to Holly Court. There was also evidence that care planning had been based on the outcome of this assessment. One returned service user survey commented that Holly Court was excellent at giving information. Holly Court does not offer intermediate treatment. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health, personal and social care needs are met by the implementation of policies and procedures. Staff practices also serve to promote the dignity of the service users. Evidence: The quality in this outcome group at the last key inspection was found to be good. The AQAA submitted by the manager reported that all service users had an individual plan of care which was reviewed on a monthly basis. Comment in surveys which were returned to us by service users or their relatives included I would not want my [ relative] in any other home our relatives cannot ask for much herself due to the severity of her dementia but when we have asked (for example for an optician to sort her new reading glasses) on her behalf, it has been acted on soon. All people who returned the survey said that they received the care and support they needed either always (4) or usually (1). One relative who completed a survey form was not consistently happy with the care their relative received, citing Care Homes for Older People Page 12 of 27 Evidence: difficult communication with a multicultural workforce. Other people gave a different picture. One relative commented it is very difficult to leave a loved one in the care of others and fully trust them to care for them properly. However this has not been the case with [relative]. I can totally rely on the home to provide for his needs both physically mentally and also socially. I know that they respect his wishes and also treated with dignity. During this site visit service users were observed to be living in a calm and relaxed atmosphere. One relative who was interviewed said that their relative had been at another home but since moving to Holly Court their behavior had significantly mellowed. A selection of service users files was looked at. There was documentary evidence that all had a written plan of care which was periodically reviewed. There was also documentary evidence that relatives had been involved in the care planning process. Some relatively minor administrative errors were identified (for example one service user appeared to lose 2 inches in height within a month - without this record being queried). However, there were more examples of good links being maintained between the assessment process, the care planning process and the daily recording process. The manager reported that he undertook an audit on a sample of care files each month. This would help to improve and maintain appropriate standards in the documentation. Good documentation allows staff to demonstrate the quality of care they are offering. Staff who were interviewed said that in addition to the written care plans there was a verbal hand over at each change of shift. All staff who were asked said they were confident that they were kept up to date with the changing needs of individual service users. There was documentary evidence that service users have access to appropriate medical support. This was also confirmed by discussion with service users relatives and staff who were interviewed. Medication presented as being appropriately stored. A selection of medication administration records was looked at. All but one presented as being appropriately maintained. The one exception seen was where some medication was recorded as having been refused, but the actual tablets which should have been stored pending disposal could not be found at the time of the visit. The manager reported that no service user was self administering medication and that no service user was prescribed controlled drugs. Care Homes for Older People Page 13 of 27 Evidence: All visitors and staff who were spoken to expressed the view that service users had their privacy and dignity maintained. One relative said that they had never seen such devotion to care as seen here. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An appropriate range of activities was available for service users, and visitors are welcome in the home, which enhances service users fulfillment and social stimulation. The provision of food to maintain service users health and well-being is good and service users are able to maximise their autonomy within the context of communal living. Evidence: At the previous key inspection quality in this outcome area was considered to be good. The AQAA stated that service users were treated as individuals with input from families to create a social and life history. A dedicated activities coordinator is employed for 20 hours a week and a schedule of activities was seen on the noticeboard on the foyer. Discussion with the activities coordinator indicated that this schedule was a guide which was flexible enough to incorporate the daily wishes of the service users. For example, on the day of the site visit the weather was pleasant, so activities were being undertaken in the garden area. Completed surveys confirmed that outings also took place including, for example, trips to pubs, Harry Ramsden, barbecues, Halloween and Christmas parties. Care Homes for Older People Page 15 of 27 Evidence: One relative wrote there is always a homely friendly feel about the place and the residents feel relaxed. Staff seem pleasant and caring to the residents. Our relative feels like she is in control of her daily routine while the staff guide her through it at her own pace. Another wrote [staff are] helpful to families when visiting. Staff who were asked stated that they believed that service users were able to exercise autonomy and choice within the context of communal living and their mental and physical health. One member of staff said that residents could have choice and this is not an institution. All visitors who were asked confirmed they were able to visit at any reasonable time and that they were made to feel welcome by the staff team. One mealtime was observed, in part. As at other times of the day this presented as being relaxed and unhurried. A planned written menu, including a choice, was available in the foyer. The manager reported that due to the poor memory of most service users each was asked which choice of meal they wanted at the actual mealtime. Meals are prepared in an adjacent care home. The kitchens were not looked at during this visit although we were invited to by the chef. One meal was sampled during this visit. It was pleasantly presented and tasty. Visitors who were asked believed their relatives enjoyed the food at Holly Court. One person who returned a survey the staff of Holly Court are thorough, friendly and helpful. They organised good entertainment and outings. As far as the food is concerned the menu is very good and varied and [relative] is very happy there and I trust them to meet his needs. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are protected from abuse or exploitation by the homes policies and practices and are confident that any complaint they may have would be dealt with appropriately. Evidence: At the previous key inspection quality in this outcome area was considered to be good. There were written complaints procedures and policies and procedures in place which served to protect residents from abuse. These policies and procedures were not looked at again at this visit. The complaints log was available for inspection and the manager reported that there had been no complaints received since May 2007. Discussion with visitors indicated that there had been complaints about the service more recently and people were happy that these had been sorted out quickly. The manager had identified in the AQAA that an improvement could be using the complaints system as a positive quality assurance system. It would only be possible to achieve this if staff were encouraged to record all complaints even when they are immediately resolved. All visitors who were spoken to were confident that both the staff and management would take any complaint seriously and respond appropriately. Relatives who completed a survey form all knew how to make a complaint and all but one who Care Homes for Older People Page 17 of 27 Evidence: answered the question said that they always received an appropriate response to concerns. The one person who said concerns were only appropriately responded to sometimes, wrote that they had raised an issue in connection with continence management of their relative several times without the issue being resolved to their satisfaction. All staff who were interviewed during the inspection were confident that the management team would deal with any concern or complaint appropriately. All visitors who were asked reported that they were confident that their relative was safe at Holly Court, in that they were protected from abuse or exploitation. Similarly all staff who were interviewed believed that service users at Holly Court were protected from abuse or exploitation. Staff presented as being aware of the whistleblowing procedures and expressed confidence that, if necessary, they would whistle blow. All staff who were asked confirmed that they had received training in safeguarding adult procedures. This was backed up by documentary evidence which indicated that all staff had received POVA training. We were aware of an allegation of financial abuse which, at the time of this visit, was reported as still being dealt with by appropriate external agencies. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately maintained, decorated and cleaned to enable service users to live in a pleasant, safe and hygienic environment. Evidence: At the previous key inspection quality in this outcome area was considered to be good. The manager reported in the AQAA that the home and its equipment remained well maintained, that there was a fire risk assessment in place and specialist equipment could be made available when required. During this unannounced site visit a tour of the building was undertaken. This included communal areas both inside and out and a selection of service users bedrooms. Good evidence was observed of service users being able to personalise their own rooms. Bedroom doors had been painted and fitted with false letterboxes and other door furniture to create visual cues for residents. The manager reported that the dining and lounge areas had been painted in the last 12 months. The building presented as being clean and tidy with no unpleasant odours and no issues relating to be building were identified as needing any action. Visitors and staff who were spoken to reported that this was the usual state of Holly Court. Of the relative surveys which were returned all said that the home was clean and fresh either Care Homes for Older People Page 19 of 27 Evidence: always (3) or usually (2). As with the kitchen, laundry facilities are provided in an adjacent care home. Staff reported that they had received training in infection control and that personal protective equipment was always available for their use, to minimise the risk of cross infection. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skills mix of staff on duty promotes the independence and well being of service users. Recruitment procedures are not always followed sufficiently thoroughly to minimise the risk to service users of inappropriate staff being employed. Evidence: At the previous key inspection quality in this outcome area was considered to be good. The manager reported that staffing was provided on the basis of two carers on each of the two floors during the day. A copy of the staff Rota for the week beginning 14/09/08 was provided for us. This provided confirmation that four care staff were on during the day and three at night. Ancillary staff, including domestic laundry and cooking, were in addition to these hours. Some visitors and people who completed surveys queried whether these staffing levels were adequate. Visitors who were spoken to were unable to identify any specific incidents where the numbers of staff had been problematic. Staff who were asked reported that staffing levels were appropriate for the dependency needs of the service users. Care Homes for Older People Page 21 of 27 Evidence: Training records indicated that of the 11 care staff 8 had NVQ II or above. A small selection of names from this group was chosen and in all cases certificates confirming their qualification was seen. It was reported that a range of other training opportunities were available and again, there was documentary evidence to confirm this. Staff who were asked reported that the management team and the organisation encouraged staff to receive appropriate training. There was good documentary evidence that new staff received an appropriate induction training package. This was also confirmed in discussion with staff. Staff also reported that they had regular supervision and appraisals. The manager reported in the AQAA are all staff who were recruited had two written references and a POVA first or full CRB (criminal records bureau) disclosure before starting work. A selection of files relating to staff recruitment and vetting was looked at. In all the examples seen there was documentary evidence of references and CRB checks having been undertaken. However, none of these records contained a full and complete employment history of the applicant. There was no evidence to suggest that any applicant was concealing any information, but the failure to obtain a full history, including an explanation of any gaps, made it difficult for the manager to demonstrate that a reasonable decision had been made to appoint each individual. Some people who completed the surveys said that they felt some staff needed more training, while others reported favourably. Visitors who were spoken to were positive about the staff team. One person described the staff as superb, never been any different. Another said the best thing about the home was care and attention and good staff, while a third described the staff as very kind and polite. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and staff are protected by the effective implementation of the homes health and safety procedures. Evidence: The acting manager had, at the time of this site visit, not been put forward for registration with the Commission. During the visit he presented as competent and knowledgeable about the service users. Several visitors spoken to, particularly commented that it was the manager to whom they would take any queries, and had experience that he sorted things out. One respondent to the relative survey, when asked if there is anything else they would like us to know said just that my daughters and I am quite satisfied with the way Holly Court is run and the manager is very pleasant and understanding. We feel my husband and their father is being really looked after. There were a variety of quality assurance systems in operation at Holly Court. These Care Homes for Older People Page 23 of 27 Evidence: included meetings, the availability of the manager, regular audits undertaken by the manager and surveys for visitors to complete which were collated at the companys headquarters. No copy of any recent report based on an analysis of this information was available to be looked at during this site visit. One relative survey returned to the commission said I dont think they can improve their standards any higher, they ask relatives what could be improved, I just think they act really well on feedback. A selection of records in connection with money held on behalf of service users was looked at. These presented as providing an effective audit trail to show how much was being held for each person and providing receipts for any purchases made on their behalf. These records presented as being appropriately maintained to safeguard the interests of the service users. The manager reported that staff were aware of safe working practises and all received training in moving and handling, to minimise the risk of injury either to staff or service users. Similarly basic health and safety training forms part of the induction for all staff. Staff who were asked confirmed they had received this basic training and there was documentary evidence of induction being undertaken. Previous site visits to Holly Court have confirmed good standards of the maintenance of equipment for health and safety purposes. Similarly there has been a regular routine of testing fire alarm and detection equipment. The manager reported that the company was continuing to maintain these standards. A small sample of documentation relating to health and safety testing and compliance was looked at and indicated these standards were being maintained. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The procedure in connection with disposal of medication should be thoroughly followed and documented on every occasion. This clarity would ensure that staff can be accountable for the way in which they are administering medication to the service users. The manager should ensure that all complaints are recorded, including their outcome, even if they are resolved without delay. This will enable staff to identify any patterns and modify practice or procedures if necessary for the benefit of service users All prospective staff must give a full employment history, including the reasons for any gaps. A record must be maintained of this, together with any judgements made about how anything in their history might impact on service users. This will allow the management to demonstrate that they have taken all reasonable steps to protect the vulnerable adults living at the home from inappropriate staff. The quality assurance systems should be drawn together into one report which includes an action plan for how the management and staff at Holly Court can further improve the service provided to the residents. 2 16 3 29 4 33 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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